Delusions are false beliefs that are held in spite of a lack of evidence or even evidence to the contrary. For example, a delusion might be believing that the FBI is surveilling you every day or that you can predict the future. Delusions are a part of psychosis which can be present in bipolar depression or bipolar mania. Delusions are easiest to spot when they’re exaggerated, like in the above examples, but I would suggest that delusions are much more common when we give them credit for. I would suggest that delusions are present in most cases of severe bipolar depression.

It is an unfortunate reality that some people with bipolar disorder refuse help. And it is an unfortunate reality that this deleteriously affects those in their lives. And it is unfortunate that some people are tied to those that refuse help, such as in the case of a marriage or partnership. So the question is, if you are married to a person with bipolar who refuses to get help for their illness, should you leave them?

One of the most controversial things the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) did was remove the bereavement exclusion from the depression diagnosis. Previously, people grieving the loss of a loved one couldn’t be diagnosed with depression for two months after the loss. Now, however, this is no longer the case. Now, even a person grieving the loss of a loved one can be diagnosed with depression. And some people say this is a further medicalizing of normal emotion. I, however, would argue that there was a good reason for this change and that skilled clinicians can tell the difference between grief and depression. Here are some ways grief and depression differ.

A normal life is something I’m not very familiar with. I’ve never really had one. From the time I was a kid with an alcoholic father, to the teenage years I spent depressed, to my adult years dealing with psychiatrists, symptoms and medication side effects, I’ve never really enjoyed anything termed normalcy. But the question is, does anyone with bipolar enjoy a normal life?

In the presentation I give to schoolchildren, I mention that, at various points in my history, I self-harmed. I cut myself. It’s a dirty truth, but there it is. And not surprisingly, one teen asked me today, “Why would anyone cut themselves?” Good question. Whole books have been written exploring this question and there is no single answer to why people self-harm. However, as to why most self-harm: it seemed like a good idea at the time.

Bipolar places limitations on our lives. It might be the fact that we can’t go out and enjoy a cocktail after work or it might be the fact that we can’t stay out all night. Or it might be the fact that we can’t work full time or that we have to live with medication side effects that make us sick. Limitations are there, no matter how you look at it. But what happens when you don’t respect those limits? What happens when you choose to ignore them? I can tell you. You feel like a dog’s breakfast. Just ask me. I did it on Monday.

In psychiatric studies, generally response and remission are recorded for the effectiveness of medications. So, a certain percentage of people positively respond to medications (get somewhat better) and a smaller percentage of people go into remission (get mostly better) from medications. The definitions of “respond” and “remit” vary, but typically it’s a reduction in symptoms, as measured on a scale, to a specified degree. In practice, this means that a medication can still be deemed “effective” even if it only moves you from a 10 to a 5 on a scale of depression. Well, this isn’t good enough.

While it seems hard to believe, some people want others to stay mentally ill and, indeed, sometimes even individuals themselves, choosing to maintain mental unwellness. You have the obvious example of people refusing medication and thus becoming very sick but there are other forces as well that can encourage a person to stay acutely, mentally ill.

There is something I have noticed about my busy bipolar brain. I’ve noticed that it seems obsessed with multitasking. It almost seems to not allow me to do one thing at once. If I sit down to watch TV, for example, I can’t stop myself from also picking up my computer or playing a game on my cell phone. When I sit down to write an article, I have to constantly also be checking in on my social media at the same time. People always wonder how I can be everywhere at once. That’s easy. I’m everywhere at once because my brain is everywhere at once.

Bipolar moods vary in duration by person but typically, an untreated bipolar mood can last months or even years. All a bipolar disorder diagnosis requires is the presence of one manic/hypomanic mood episode and one depressed mood episode. This means that a person could be in a year-long depression and have only experienced one week of mania, a year ago, and still qualify for a bipolar diagnosis. This is much to the surprise of many as there is a pervasive belief that bipolar disorder is about frequent “mood swings.” However, simply “being moody” is not indicative of bipolar disorder.